telehealth – Community BlogYour source for Health IT Exchange community happenings and member highlights2016-11-07T21:06:24Zhttp://searchhealthit.techtarget.com/healthitexchange/CommunityBlog/feed/atom/adelvecchiohttp://searchhealthit.techtarget.com/healthitexchange/CommunityBlog/?p=21122015-06-03T18:14:56Z2015-06-03T18:07:59ZGuest post by John Smithwick, CEO, RoundingWell

The rise of transformative technologies from EHRs to wearables is quickly making mobile devices a very real part of the healthcare journey. American adults spend an average of 43 hours per month using apps or surfing the Web on their phones, compared to just 22 minutes spent at an average doctor’s visit. Mobile devices make information instantly available to far more people, integrating them with our daily lives more than traditional desktop computers ever did.

Clinicians are also seeing how important mobile devices can be, not only for their patients, but as tools to help them deliver quality care in a more timely and cost-efficient manner. According to a survey released during the HIMSS 2015 conference, 54% of healthcare provider employees that use mobile devices to engage with patients have seen cost savings.

The rise of this collaborative approach to healthcare is one of the crucial steps in the journey toward a more time- and cost-efficient, value-based healthcare world. By utilizing mobile devices — which are already an ingrained part of people’s everyday lives — clinicians can tailor delivery of care, while also receiving data that can have an impact on patient outcomes.

Support ongoing, two-way conversations
The saturation of text messaging and social media has conditioned people to expect instantaneous communication. By deploying patient engagement technology, clinicians and patients can use mobile devices for secure, ongoing, two-way conversations that are more aligned with modern communication.

The ability to engage in an open-ended discussion can break down communication barriers, make patients more comfortable with physicians and transform patients into a resource for health information. In addition to increased patient satisfaction, establishing ongoing communication can also lead to earlier identification of potential adverse health events.

Share tailored, bite-sized content
We live in a hyper-connected world that is measured in 140 characters, and marked by messages that disappear after 24 hours. Health content is no exception: Care information must be delivered in small, digestible chunks relevant to patients and accessible anywhere, anytime.

Technology allows healthcare organizations share educational content — such as how to deal with a chronic condition — with the touch of a button, and helps them customize a treatment plan specific to each phase of every patient’s healthcare journey. Are you treating a diabetes patient who has just been discharged from the hospital after a life-threatening rise in blood sugar? Serve them with content that includes one low glycemic recipe a day. By using content to engage patients on a regular basis, clinicians can help proactively prevent readmissions and earn the trust of patients.

Remote monitoring
The number of hours available to engage with patients is often severely limited by the time it takes to chart all the information from a visit. While patients may get less than 30 minutes of a clinician’s time, a physician can spend as much as a third of a work day charting. Patient engagement technology allows physicians to reclaim some of those hours by making it easier to monitor patients from afar.

In addition to patient-provided health reports, HIPAA compliant monitoring devices allow physicians to monitor heart rate, blood glucose and other biometrics. In doing so, clinicians can spot health events and address them before they lead to a costly hospital visit.

Grant access to real-time data
Patients and providers are both hungry for real-time data — and patient engagement technology can provide it via mobile devices.

For clinicians, the ability to answer patient questions, check in and conduct health visits via mobile devices provides a stream of data that can be collected and analyzed on a rolling basis. These modern technologies help save time by eliminating many of the hours spent manually charting, faxing records and hand-entering medical data. For patients, this technology can integrate with some EHRs and other health information systems to provide a more complete picture of their health.

New ways to execute telehealth visits
Mobile devices also provide clinicians an avenue through which they can execute virtual visits in a way that enables the patient to see the face of their doctor (making the visit feel more real) and connect with physicians that might be out of state, while helping clinicians save money and resources. In fact, most clinicians can bring more dollars in the door without affecting patient satisfaction by using Current Procedural Terminology codes when practicing telehealth.

To stay relevant and solvent in this new world, healthcare organizations must start looking for technologies that integrate with the mobile lifestyle of patients and also deliver quality, easy-to-access data for physicians.

About the author:John Smithwick is the CEO of RoundingWell. He co-founded RoundingWell in 2011 following four years at Nashville’s Healthways, where he led the design effort for their web-based disease and lifestyle management product offerings. Prior to his work at Healthways, he worked in product management at Microsoft in Redmond, Wash. and in technology strategy consulting with Accenture in Boston, Mass. A graduate of the University of Richmond, he holds a master’s of business administration from the University of Pennsylvania’s Wharton School of Business.

1. What unique challenges do small physician practices face compared to their larger counterparts in regard to EMR adoption?

Independent small physician practices (1-5 doctors) differ significantly in their approach to shopping for, and acquiring, EMR products. The big boys, especially when you are talking 50 or more physician practices typically have committees and consultants involved in the selection process.; That means the eventual users of the technology are often times not directly involved in the tire kicking process that goes on before a vendor is signed. With a small practice, most often the user IS the buyer – and this changes everything.

Doctors in any size practice are typically very busy. Small practices are essentially small, independent businesses, where doctors are providing care, and also carrying out numerous administrative tasks as well (I know of one solo practitioner who even cleans his exam rooms each evening). The result is that these practitioners have very little time to commit to researching and test-driving EMR products. Remember, there are literally hundreds of EMRs to choose from. As a result, doctors have to rely on word of mouth and Google searches to narrow their search. This can leave doctors frazzled. Studies have shown that when consumers have too much choice, they often make no choice at all. This applies to EMR shopping.

So what does this mean for small physician practices? It means that vendors have to earn the trust of the physician. I think that simply selling an EMR system, and then walking away puts the doctor in a vulnerable position – remember, their livelihood depends on this new system operating effectively. A better approach is for the physician to enter into a partnership with an EMR company. Both entities need to have some skin in the game. Both need to be able to work together to make the implementation, and essentially the practice transformation a success.

The large practices set aside budget, earmarked not only for purchasing an EMR, but also for finding the best EMR in the first place. The solo practitioner usually doesn’t have cash on hand to throw at this sort of endeavor. As a result, you are seeing some EMR vendors offering their products for free. This may work well for doctors who don’t mind using a system with pharma advertising embedded in the user interface. However, Hello Health takes it a big step further and helps doctors make more money with an ad-free, subscription-based technology solution.

2. As a vendor, why did you choose to focus on this part of the market?

Small, independent primary care practices need help. They face shrinking reimbursements and higher overhead and we’ve heard this many times over. Hello Health has always been about keeping the independent practice independent. We survey physicians regularly and their main concern is safeguarding their autonomy. They would much rather work for themselves instead of for the institutions we associate with large practices and hospitals. I think control plays a large part in their drive to remain independent. Control over how they practice medicine.

From the beginning we realized that primary care was feeling the pinch more than most specialists. We also understand that family medicine is more relationship-based than what you have with your average orthopedic surgeon, for example. Patients see their family doctors on a regular basis and from this, relationships are formed that may last years and years. There is value in these relationships, for both sides. Doctors get to know their patients, their patients’ families and most importantly their health as it changes with age.

We asked people what they would like to improve with their family doctors and the responses skewed overwhelmingly toward better communication. From this we developed our strategy for patients:

i. improve communication channels between patients and their doctors

ii. provide better care

We asked doctors what they would have to accomplish in order to secure their independence, and by in large they indicated that they needed to improve their finances. Accordingly, we developed our strategy for doctors:

i. make doctors more money

ii. provide better care

iii. put back time in their day

So far our strategy has worked. Doctors see how the Hello Health business model can improve their bottom line and patients, after having used our communications tools say they can’t imagine going back to a ‘traditional’ practice.

3. How will the recent $10M in funding Hello Health received be used? Will you be expanding your offerings?

The new funding will go a long way in helping us ramp up our sales and marketing efforts. We are currently active in New York, New Jersey and surrounding states, as well as Atlanta. We recently added sales professionals to cover the Southwest and mid-Atlantic regions. Because Hello Health seeks to build a partnership with each and every practice, our marketing, sales, training and implementation efforts are intensive. We are not just another vendor to a new practice. We are a partner. Getting into the details of how we partner with a practice is an interview in and of itself.

We have practices in 25 states, so our reach goes beyond our sales territories. Doctors hear about us at conferences, find us online and via our social networking presence, which we continue to refine.

4. National Coordinator for Health IT leader, Farzad Mostashari, M.D., said last week that technology alone won’t spur patient engagement because “it’s a two-way street” – patients need access to their data, but physicians also need access to patient data coming from medical devices and the like.How does Hello Health help to accomplish this bi-directional conversation that is so important to the patient / physician relationship and how do these roles need to evolve as technology becomes more widely available?

Hello Health has been at the forefront of bidirectional data exchange. From the day we went live in our first practice, our patients have always had access to their data. With each release we’ve made the patient experience better by introducing even more ways to exchange data, like our shared document library.

Dr. Mostashari is absolutely right when he says, “it’s a two-way street” but I would argue that outside of our Hello Health practices, we’ve never really had that bi-directional conversation, so the population at large doesn’t even really know how important it could be to the patient/ physician relationship.

There’s no question that the technology exists today to easily provide patients access to their data, and conversely for patients to send data to their doctors. You don’t have to look any further than the WellBox solution within the Hello Health platform and Qualcomm Life to see what possibilities exist. The bigger question, that I don’t think anyone has a ‘real-world’ answer to is, who’s going to pay for this?

There will always be a small segment of the population who are proactive and curious enough to capture and track bio-data – and that’s great. Movements like Quantified Self (QS) seem to be gaining momentum and there is interest from the VC community. However, QS represents the extreme, and is not necessarily linked to any specific disease monitoring. They are the innovators and early adopters and I respect them for taking their health seriously. For the rest of us, consumer products like Nike Fuelband and FitBit are making inroads into our everyday lives.

But let’s say a patient is hypertensive and is monitoring their blood pressure at home. They can easily communicate this data to their physician during regular visits, and that works ok because the doctor is getting paid for that encounter. Now let’s say that the patient has a Bluetooth BP cuff and their readings can be sent automatically into the cloud on a daily basis. Let’s even say that the doctor has a dashboard where he or she can go to check on all of their hypertensives’ BP on a daily basis. This is also good, right? You would think so, but unfortunately the doctor isn’t getting paid for the time he or she spends checking this data. Neither is their nurse practitioner. And who pays for the Bluetooth BP cuff? The reimbursement mechanisms will have to change if Dr. Mostashari’s vision is to be realized.

5. Case studies of success (i.e., utilizing remote visits, etc)? What are examples of this technology in action?

Two of our earliest customers in Manhattan represent great success stories. One runs an internal medicine and hematology practice in Mid-Town Manhattan. The other has a similar practice on the Upper East Side.

Both doctors tout the merits of digitizing their practices, and for many of the same reasons. Initially, both doctors considered staying the course with paper-based charts and schedules, feeling that they would be well served by these time-honored tools. However, requests from patients for improved communication methods soon had both of them looking for alternatives. What convinced them to try Hello Health was not just the intuitive EMR, or the value of the patient’s portal, but rather how the platform was able to tie the functionality together to provide synergy and thus more value.

Dr. Colleen Edwards sums it up best when she says, “One of the unintended benefits I’ve found is the e-mail conversations that you have, or instant messaging conversations or telephone conversations, now automatically become part of the medical record. That’s a huge improvement for me.” Stated another way, it’s not enough to have an EMR, provide secure messaging and conduct virtual visits. All of these things have to be tied together. The message thread becomes much more valuable if the provider can save it automatically to the patient’s chart or attaches it to a specific visit note.

When doctors start getting paid for all of the work they do, a curious thing happens – patients start respecting their time, and doctors start making more money. During a recent interview, Dr. Edwards stated: “The feature of Hello Health that really tweaked my interest was the ability to bill for remote services, or virtual services. As an internist, I do a lot on the telephone that I wasn’t getting reimbursed for. Whether it’s a straightforward urinary tract infection or sinusitis, or someone wanting to discuss their headaches over the telephone, I was making 10 phone calls like that a day that I wasn’t getting reimbursed for, and I thought I should. And it got to the point where I thought I was being abused. I was so responsive, I always return my phone calls, and then having this ability to actually capture a little income, and make the patients realize that my time isn’t free and it’s valuable, really made my antenna go up.”

At Hello Health, when we hear stories like this we can’t help but smile. This was our goal from day one — use technology in a way that makes doctor’s lives easier, and more rewarding while at the same time providing valuable tools to patients that enhance their relationship with their doctor.

The industry also saw innovation in industry events that experienced record attendance numbers, such as HIMSS 11, ATA 11, RSNA and the mHealth Summit, to name just a few, and in game changing collaboration at both the state and federal levels making progress on data exchange, quality reporting measures enforcement (PQRS), and HIE and ACO establishment.

Here at the Health IT Exchange, our editorial and member contributors kept their fingers on the pulse of the industry, delivering hard-hitting, best-practice expertise for their colleges and peers. Below are the seven most popular blog posts from the community, touching upon just some of the prevalent industry trends, policy changes and market developments from 2011, and also shedding light on some of the key areas that health IT leaders should continue to watch as we head into 2012.

After a three-year wait, the FDA has issued a final rule that reclassifies medical device data systems, or MDDS, as Class I devices that are subject to general regulatory control and exempt from premarket notification requirements.

For a successful implementation of BI and in a patient-centric environment, there are many complex tasks that need to be addressed. With all the data that will be available to support improved outcome measures comes the responsibility of using the right business intelligence (BI) tools to assist with the analysis and trending of the data required for meaningful use stages two and three. In order to ensure that your BI initiatives are truly meaningful, you will need to follow these simple, critical steps.

Companies running on the cloud see lower costs, increased agility and improved ability to meet their business objectives. Given today’s pressures on health care, should we be prescribing a healthy dose of cloud computing to the health care industry? I think the answer is a resounding “YES.”

Today’s information infrastructures run some of the most critical elements of business and clinical operations in health care organizations. One recent lawsuit, which accused a hospital of failing to adequately prepare for a catastrophe (Hurricane Katrina), highlights the challenge with disaster preparedness. The case raises the legal standard by which hospitals and other health care entities may be judged and increases the risk of being sued over emergency preparedness — specifically, not being prepared for nearly every contingency. So where should a CIO or IT department start?

With the release of iPhone 4S and the deployment of the new Siri as part of the iOS 5, it is clear that the new voice assistant will ultimately find a place in the health care industry. The only question that remains is, “in what capacity?”

This morning a friend told me about a 60-year-old man who died suddenly of heart failure. What was interesting about his story is that he had a history of heart problems, and in the weeks leading up to his death he had told some friends about symptoms he was experiencing, but he never told the person who really needed to know: his doctor. A simple telephone call might have saved his life.

Telehealth services are designed to increase accessibility to care, and one federal agency is realizing the benefits. The Department of Veterans Affairs (VA) leads the way in telemedicine, offering three levels of telehealth services to its veterans.

7. Views from the top: On health information exchange and RECs: In this Health IT Exchange Live Chat, experts from three state regional extension centers (RECs) stopped by to share their perspective on balancing the requirements of meaningful use compliance, ICD-10 migration and privacy updates while achieving health information exchange (HIE). The REC leaders also gave advice to end users working with local RECs for EHR adoption and integration.

Find out how the South Florida REC is communicating with physicians about data integration and how information exchange can help providers manage referrals. Also learn how Pennsylvania is bringing all the major stakeholders to the table, a crucial element in building trust, while providers in Rhode Island are being motivated to see the value of exchange.

]]>1Jenny Laurellohttp://searchhealthit.techtarget.com/healthitexchange/CommunityBlog/?p=5772011-12-20T17:03:18Z2011-12-20T16:50:17ZWhile onsite at this year’s mHealth Summit in D.C. earlier this month, I had the opportunity to chat with Gigi Sorenson, director of Clinical Specialty Programs at Flagstaff Medical Center, who is currently leading the development and implementation of FMC’s Telemedicine Program. Supported by a collaboration of providers and industry innovators who are utilizing mobile technology and telehealth to achieve a new degree of care coordination and connected health, the program includes the development of Care Beyond Walls and Wires and the flagship TeleStroke partnership with Mayo Clinic in Scottsdale, Arizona.

Identified as one of the medical center’s top three initiatives in 2012, Gigi was excited to share with me the details of the program, including sending home their very first patient and family enrolled in the program with their connected devices that very day, and shed light on some of the new mhealth innovations that will be coming down the pike at the organization in the upcoming months and years.

]]>1Jenny Laurellohttp://searchhealthit.techtarget.com/healthitexchange/CommunityBlog/?p=2802015-01-30T20:59:23Z2011-05-13T13:50:57ZA major consideration in the success of telehealth technologies and the utilization of medical mobile applications is the population group with which you’re working. Formulating a remote patient monitoring program can become even more challenging — or not– when that group is composed of adolescents and teens. At this year’s 16th Annual American Telemedicine Association conference, Dr. Joseph Caffazo, senior director of eHealth innovation at the University of Toronto, shed light on a new iPhone app for diabetic teens that monitors and reports on blood glucose levels remotely. It also taps into the vast opportunities that now exist through social media platforms.

bant, a collaborative effort between Apple and the University of Toronto’s Hospital for Sickkids, is being touted as the “diabetes app for the ePatient,” and is the first example in a clinical trial where a glucometer is communicating directly with an iPhone. The app works like this: patients enter their readings with a single swipe, and the results get instantly stored to a Google Health account. You are then able to share your experience with the diabetes community directly through Twitter, giving the patient experience its own portal for communication. To hear Dr. Caffazo explain the app, please visit the ATA’s press conference coverage page and zip ahead to 23:00.

With the usage of smartphones and mobile applications on the rise in both business and personal settings, Apple and the University wanted to create a unique user experience that made diabetes data monitoring an interactive, engaging daily activity – one which teen patients would no longer see as a chore, but instead an opportunity to both improve their health and connect with others just like them.

In addition to being able to tweet directly from the app’s platform, users are also invited to participate in the corresponding community forum and blogosphere, where they can share their stories and connect with other teen diabetics. There is even a rewards system of sorts baked right into the app, where users receive iTunes currency in return for their regular monitoring and reporting.

While it is impossible to force a patient to actively participate in remote monitoring activities, bant is a great example of how industry innovators are working hard to expand the continuum of care and drive patient engagement through mHealth and social media. As Dr. Caffazo noted at ATA 2011, “The next generation of remote patient monitoring systems will be mobile phone based. Why? Because we need to address the huge numbers of people with chronic conditions […] many of the current technology can only deal with hundreds and thousands, and we really need to leverage the ubiquitous of the mobile phone.”